An article addressing how Obsessive-Compulsive Disorder (OCD) interacts with religion has a way of drawing out many initial concerns from a reader, such as, “Is this writer going to blame my religion for OCD?“ Or “Acting religiously compulsive doesn’t sound so bad… at least it’s not drugs or gambling.” Or “Does the writer think my religious practices are due to a psychological disorder?” 

My goal is to help the scrupulous individual recognize when OCD may be interfering with their devotion to God—not to diminish a life of devotion to religion. What really are devout expressions of faith? And what faith practices may be driven by OCD? Here are a few scenarios illustrating the complexities of scrupulosity: 

• Jan, a devout Catholic, was again confessing sins to her priest that she had already confessed many times before. 
• Marcus, a theology student, was regularly experiencing doubts about his faith, and repeatedly reviewing time-consuming proofs for and against the existence of God, despite already concluding that his doubts were irrational and knowing that he was neglecting his school work and family time as a result. 
• Mary, after months of counseling, worked up the courage to share her “unmentionable sins,” which she described as unwanted sexual thoughts about her church’s minister. She was unbearably ashamed and guilt-ridden by such thoughts. 
• Eric was avoiding certain peers at school concerned that he would hear blasphemous words and inadvertently sin by thinking about those words throughout the week. 

 Are the above scenarios examples of scrupulosity? Before we jump to any conclusions, let’s take a closer look at the elusive nature of OCD. If you would first like a more general overview of OCD, please read Ashley Yergler’s recent blog post OCD: When the Brain Misfires Danger Cues (2019).

OCD as an Elusive Opponent 

To unravel the complexities of scrupulosity, we need to better understand the shape-shifting nature of OCD–scrupulosity as one of OCD’s hard-to-recognize disguises. Here are some examples of how OCD can elude us:  

• Attempts to push away and ignore obsessions often trigger more obsessions. Fear and guilt can cause a rash of obsessive thoughts, sometimes referred to as mental hiccups. 
• While compulsions are soothing to the sufferer, they eventually stop working. New compulsions are added, increased, and repeated to recover the same soothing effect, and thus become very time-consuming. 
• Family and friends may get enlisted by the sufferer as part of the soothing ritual. 
• Obsessions can change, evolve, and resurface regularly. As certain obsessions fade or are defeated, new obsessions can take their place. For example, religious obsessions may change into cleaning obsessions, and then later back to religious obsessions. 
• For the sufferer, just recognizing thoughts and behaviors as obsessions and compulsions can be as difficult as treating the symptoms. And if the disorder changes shape, the sufferer may no longer recognize the OCD. 
• Mental compulsions, a less visible type of compulsion, can be particularly difficult to recognize. Examples may include constant requests for reassurance from a loved one, mental checking, and constant silent prayers to relieve guilt. Unfortunately, scrupulosity thrives on these mental compulsions.
• The sufferer may keep his or her “forbidden thoughts” secret due to the incredible shame experienced by the sufferer, not recognizing these thoughts as OCD. 

What is Scrupulosity? 

Scrupulosity, sometimes referred to as Scruples, the Doubting Disease, and Religious OCD, is considered a form of OCD involving religious or moral obsessions. Scrupulous individuals are overly concerned that something they thought or did might be a sin or other violation of religious or moral doctrine (International OCD Foundation, 2010). Joseph Ciarrocchi, PhD, author of The Doubting Disease, writes, “The term ‘scrupulosity’ refers to seeing sin where there is none. Some call it a ‘phobia concerning sin’. The person judges personal behavior as immoral that one’s faith community would see as blameless” (Ciarrocchi, 1995, p.5). 

Obsessions, for the scrupulous, can feel deeply shaming and fearful. Sufferers can shift from unwanted blasphemous thoughts, to fears of disappointing God, to thoughts about sexual indiscretions—whatever topics tend to provoke the most guilt and fear. 

Families of the scrupulous can also suffer. Often entangled by the disorder, families may give constant reassurances or become subjected to rigid faith practices impacting their daily routines. Children of the scrupulous may also have trouble coming to terms with their parent’s faith—often associating that faith with their parent’s fears and guilt. Children of the scrupulous may be at greater risk for leaving their family’s faith or avoiding religion altogether. 

Beliefs that Keep the Scrupulous Doubting 

The beliefs of the scrupulous can make recognizing and overcoming Religious OCD so much more difficult. The book Overcoming Obsessive Thoughts, by Christine Purdon and David Clark (2005, p. 96-113), describes several beliefs or “appraisals” associated with scrupulosity. Here are the authors’ key appraisals often adopted by the scrupulous: 

• Thought-Action Fusion. The belief that “bad thoughts are as immoral as bad actions.” 
• Moral Perfectionism. The belief that “you should strive for a perfect moral state.” 
• Intolerance of Uncertainty. This belief refers to “the efforts to attain an absolute level of certainty in order to counter their doubts.” 
• Control of Thoughts. The belief that “you must exercise better, or even complete control over your obsessions.” Unfortunately, thoughts are not always controllable. 

Purdon and Clark’s book is an excellent resource to help sufferers recognize the tendencies that may keep them stuck. 

Treating Scrupulosity 

If you are exploring treatment for scrupulosity, I believe there are three powerful interventions to consider: counseling, spiritual direction, and medications. While each intervention may be effective on its own, a combination of these are often required to overcome scruples. 

• Counseling. Clinical counseling has very concrete and specific strategies to help someone suffering from OCD. Treatment will often involve some form of Exposure Response Prevention Therapy (E/RP) and Cognitive-Behavioral Therapy. Group therapy and support groups can also be helpful. If you are considering therapy, then consider working with a clinical therapist from a similar religious background or at least someone with a working knowledge of your faith. The therapist’s familiarity with your religion, sect, or denomination can help you differentiate your religious devotion from your scrupulosity. 
• Spiritual Direction. Don’t navigate your faith alone. Consult with your pastor, priest, rabbi, imam or someone recognized by your religious community as a reliable source. Ministers and priests in most faith traditions believe scrupulous preoccupations are not in line with the spirit of their religious teachings. A religious mentor can help you keep perspective on the most essential practices of your faith. At times, it may be helpful for your minister and your counselor to work together to give you the confidence to move forward with an agreed-upon treatment plan. 
• Medication. At times, counseling and spiritual direction are not enough. OCD and scrupulosity have a biological component. Anti-depressants are most commonly prescribed for OCD. Consult with your family doctor or a psychiatrist if interested in considering medications. 

Scrupulous or Devout? 

The stories in the opening paragraph are all examples of scrupulosity. 

• In Jan’s case, confessing once to her priest would have been sufficient according to the Catholic Sacrament of Reconciliation. Jan may be intolerant of uncertainty—doubting if she actually confessed her sin or if her confession lacked sincerity. 
• For Marcus, while his theological proofs may be helpful for life in ministry, his need to repeatedly soothe his doubts, despite knowing how to counter them, was interfering with his academics and his family life. 
• Mary is plagued by “immoral” thoughts that are not directly under her control. The more disgust and shame, the more likely she is to experience such thoughts—control of thoughts and thought-action fusion are active here. 
• Eric’s avoidance of peers at school illustrates both his need for control of thoughts and his moral perfectionism. 

A Warning When Considering the Faith Practices of Others 

Not all repetitive rituals and faith practices are driven by obsessive fears. Many devoted believers in multiple faith traditions share that their faith practices contribute to an abundant religious life shared within a community of believers. Such believers do not experience a life of shame and fear as described by the scrupulous. 

Differentiating acts of devotion from scrupulosity can be difficult for both the scrupulous and those caring for the sufferer. With the right treatment, support, and some courage, people can recover from OCD and still live a devout life in their faith. If you think you may be suffering from scrupulosity, or if you know someone who may be looking for help, please don’t hesitate to reach out. Find out more about our counselors at www.cherryhillcounseling.com. 

Some Take-Aways for the Reader 

Want to learn more about scrupulosity? Here are several resources to get started: 

• Overcoming Obsessive Thoughts: How to Gain Control of Your OCD, a book by Christine Purdon and David Clark. 
• The Doubting Disease: help for scrupulosity and religious compulsions, a book by J.W. Ciarrocchi 
• A blog about scrupulosity from a Catholic perspective: https://scrupulousanonymous.org 
• The Ten Commandments for the Scrupulous (Also from a Catholic perspective)
• Popular novel The Devil in the Details by Jennifer Traig (A Jewish perspective)

Works Cited 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.), 235, Arlington, VA: Author. 

Yergler, A. (2019) OCD: When the brain misfires danger cues. Cherry Hill Counseling. Retrieved from https://cherryhillcounseling.com/ocd-when-the-brain-misfires-danger-cues/. 5 Nov. 2019.

Ciarrocchi, J. W. (1995). The doubting disease: Help for scrupulosity and religious compulsions. New York, NY: Paulist Press. 

March, J. S., & Mulle, K. (1998). OCD in children and adolescents: A cognitive-behavioral treatment manual. New York, NY: Guilford. 

Pollard, A. C. (2010). Scrupulosity. Boston, MA: International OCD Foundation. 

Purdon, C., Clark, D. (2005). Overcoming obsessive thoughts: How to gain control of your OCD. pp. 96-113. Oakland, CA: New Harbinger Publications. 

Ten Commandments for the Scrupulous. (2015, October 23). Retrieved from https://scrupulousanonymous.org/2013/01/01/ten-commandments-for-the- scrupulous-2013/. 

Traig, J. (2006). Devil in the details: Scenes from an obsessive girlhood. New York, NY: Back Bay Books.